Serum concentration of adhesion molecules in postoperative biliary atresia patients: Relationship to disease activity and cirrhosis

Abstract

Background/Purpose: Biliary atresia (BA) is associated with progressive liver fibrosis, which may be mediated by immunologic abnormalities involving adhesion molecules. This study investigates the relationship between serum intercellular adhesion molecule-1 (sICAM-1), serum vascular cell adhesion molecule-1 (sVCAM-1), and the clinical and histologic severity of BA. Methods: Serum ICAM-1 and VCAM-1 levels were measured by enzyme-linked immunosorbent assay in 35 patients with BA and 20 healthy controls. Standard liver function tests (LFTs), and frozen section liver biopsy specimens were used to determine liver status. On the basis of LFT results, the BA patients were classified into group I (n = 10; normal LFTs), group II (n = 15; elevated LFTs, anicteric), and group III (n = 10; elevated LFTs, icteric). Eight subjects in group II, and all subjects in group III had portal hypertension (PH). Results: sICAM-1 levels were significantly elevated in group III (1760.0 ± 717.5 ng/mL) compared with group II (555.1 ± 199.4 ng/mL), group I (272.1 ± 59.9 ng/mL) and controls (256.3 ± 71.6 ng/mL). Although sVCAM-1 levels were significantly elevated in group III (1932.9 ± 282.6 ng/mL) compared with group II (1054.3 ± 297.0 ng/mL), group I (605.4 ± 112.4 ng/mL), and controls (616.0 ± 112.0 ng/mL; P <.001), there was no statistically significant difference between groups I, II, or controls. sVCAM-1 levels were elevated significantly in BA subjects in group II with PH (1253.0 ± 245.1 ng/mL) compared with those who did not have PH (827.3 ± 151.7 ng/mL; P <.01). PH did not affect sICAM-1 levels. There was strong expression of ICAM-1 and VCAM-1 in proliferating bile ductules, endothelial cells, and liver cells in group III compared with group II and controls. Conclusions: In BA, sICAM-1 and sVCAM-1 levels could be useful as markers of end-stage liver disease, with sVCAM-1 being more specific for PH. Induction of ICAM-1 and VCAM-1 may be an important factor in the development of cirrhosis. J Pediatr Surg 36:1297-1301. Copyright © 2001 by W.B. Saunders Company.